Graduate Registered Nurse and Registered Midwife – Graduate summary
Applicant Details :
Surname : / Given Name : /Date of Birth / Gender : Male/Female /
Address : /
Suburb : / Post Code : /
Phone : / Mobile No : / Email address : /
Residency status : Australian Citizen, permanent resident, Visa (if on temporary visa, please indicate expiry date) / Do you identify as an Aboriginal or Torres Strait Islander person? Yes/No /
Tertiary Details :
University : / Course commencement date : dd/mm/yyyy /Education course : / Course completion date : dd/mm/yyyy /
GPA : / AHPRA Registration : If registered /
Hospital and Health Service (HHS) – First Preference - (You must list the hospitals or facilities that correspond to the HHS that you nominated as your first preference in your on-line application form).
Name of First preference of Hospital and Health Service : /Facility/Hospital : / Clinical Area preferences : /
1st / 1st /
2nd / 2nd /
3rd / 3rd /
Hospital and Health Service (HHS) – Second Preference - (You must list the hospitals or facilities that correspond to the HHS that you nominated as your second preference in your on-line application form).
Name of First preference of Hospital and Health Service : /Facility/Hospital : / Clinical Area preferences : /
1st / 1st /
2nd / 2nd /
3rd / 3rd /
Support statement (knowledge, skills and abilities that you can offer)
Support statement (Why you chose these HHSs as your preferences)
Clinical placements during undergraduate degree : (most recent placements at the top)
Start date / Completion date / Hospital/facility / Clinical setting /Most recent dd/mm/yyyy / dd/mm/yyyy /
Least recent /
Employment history : (most recent employments at the top)
Organisation / Work Unit / Position / Date Commenced / Date completed /Most recent / dd/mm/yyyy / dd/mm/yyyy /
Least recent /
Professional referees :
Referee name : / Referee name /Organisation : / Organisation : /
Position : / Position : /
Phone : / Phone : /
Email : / Email : /
Graduate Registered Nurse and Registered Midwife – Graduate summary
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